Asymptomatic women

A significant proportion of breast cancers are diagnosed through mammographic screening in women who are asymptomatic. Assess a woman’s individualised risk to see whether a personalised screening regimen may be appropriate.

Early detection through screening mammography has several benefits including improved mortality rates, increased treatment options and improved quality of life (Cancer Australia 2015a). For women with small tumours at diagnosis (< 10 mm), there is a more than 95 per cent five-year survival rate (Cancer Australia 2012).

BreastScreen Australia services operate within the framework of a comprehensive set of national accreditation standards that specify requirements for the safety and quality of diagnostic tests, timeliness of services and multidisciplinary care.

State, territory and federally funded two-yearly mammographic screening is offered to asymptomatic women from the age of 50 to 74 years through the BreastScreen Australia program (although available after 40 years of age upon request).

A doctor’s referral is not required for screening through BreastScreen Australia, but general practitioners’ encouragement is a key factor in women’s participation in screening.

Not all breast cancers are detectable on screening mammograms, and new cancers may arise in the interval between mammograms. Women should be aware of the look and feel of their breasts and report concerns to their general practitioner.

Women invited to screening should be provided with information about the risk and benefits of mammographic screening.

There is a 42 per cent reduction in risk of dying from breast cancer in screened women (AIHW 2018b) and a significant reduction in treatment intensity for patients diagnosed within a screening program.

Screening can lead to anxiety, additional investigations for non-malignant processes, over-diagnosis and treatment of cancers that may never have needed treatment. Over-diagnosis could occur due to lesions that may not progress to invasive cancer during the woman’s lifetime. Some lesions that need investigation based on their imaging features turn out not to be cancer. Providing women with information on risks and benefits can assist them to make informed decisions around screening participation (Cancer Australia 2014).

For more information, see Cancer Australia’s position statement on over-diagnosis.

If a woman is reported as having high mammographic density please refer to the IBIS risk tool.

Symptomatic people

People who have symptoms or signs of breast cancer require prompt investigation of their symptoms, including diagnostic imaging. Screening mammography is not recommended for these people because it may lead to false reassurance and delayed diagnosis.